Provider Demographics
NPI:1336418532
Name:GARDELLA, JAMIE (RD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GARDELLA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:GARDELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9126 BLUE GRASS RD
Mailing Address - Street 2:101
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-3202
Mailing Address - Country:US
Mailing Address - Phone:215-552-8332
Mailing Address - Fax:215-552-8336
Practice Address - Street 1:9126 BLUE GRASS RD
Practice Address - Street 2:101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-3202
Practice Address - Country:US
Practice Address - Phone:215-552-8332
Practice Address - Fax:215-552-8336
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered